Developing the Cultural Awareness Skills of Behavior Analysts

The Analysis of Whose Verbal Behavior?

Recent reviews of behavior analytic journals suggest that participant demographics are inadequately described. These reviews have been limited to brief periods across several journals, emphasized specific variables (e.g., socioeconomic status), or only included specific populations. The current scoping review included all published articles in The Analysis of Verbal Behavior from 1982-2020. Six demographic variables were coded for 1888 participants across 226 articles. Despite small sample sizes (i.e., fewer than six participants in 62.3% of studies), only age (85.4%) and gender identity (71.6%) were reported for the majority of participants. Socioeconomic status, race/ethnicity, and primary language were reported for fewer than 20% of participants. Over time, the number of demographic variables reported showed a slight increasing trend, although considerable variability was observed across years. These findings suggest that editors and reviewers must consider what constitutes acceptable participant characterization. Researchers might also be emboldened to extend their work to populations currently underrepresented in the journal.

Using the ADDIE Model of Instructional Design to Create Programming for Comprehensive ABA Treatment

ABA research abounds with articles on increasing or decreasing a small set of behaviors. These articles fit nicely within the framework of Focused ABA Treatment in which the goal of treatment centers on only a few behaviors. However, many behavioral practitioners spend most of their time developing Comprehensive ABA Treatment in which a large number of behaviors are systematically changed across multiple developmental domains. Few resources are available to help in designing and implementing such programming. This article presents a model from the field of instructional design for the development of comprehensive programming. Applying the ADDIE model-Analyze, Design, Develop, Implement, Evaluate-the article identifies a consistent process to follow, critical actions to take, and helpful resources to use when developing comprehensive programming for individuals with autism.

Essential Readings in Diversity, Equity, and Inclusion in Behavior Analytic Training Programs

Cultural responsiveness is imperative for the success of behavior analysts. As topics within diversity, equity, and inclusion are emphasized within coursework and supervision, there is a growing need for resources. To date, there is limited research on suggested readings within diversity, equity, and inclusion for behavior analysts. We surveyed behavior analysts to construct a list of essential readings within diversity, equity, and inclusion and reported common publications that instructors assigned and students were assigned within behavior analytic coursework.

An Analysis of Teaching Menstrual Care Skills Using Single-Subject Methodology: A Systematic Literature Review

PURPOSE

There is a paucity in research supporting procedures to teach skills needed during an individual's menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills.

METHODS

A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC's criteria to assess the rigor of each studies' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills.

RESULTS

The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40 years of research. One study met all criteria required to receive the WWC's highest rating.

CONCLUSION

The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.

Putting Concepts Into Action: A Brief Description of 2022 BACB Ethics Code Standard 1.07 & Actionable Recommendations for Evolving Practices of Behavior Analysts

For over a decade, behavior analysts have been calling for more culturally responsive practices. Within the newest edition of the Ethics Code for Behavior Analysts, one addition in particular was Standard 1.07 Cultural Responsiveness and Diversity (Behavior Analyst Certification Board, 2020b). The inclusion of this new standard shows positive movement but there is more to unpack. This article seeks to contextualize the relevance and necessity of Standard 1.07 both at a societal level and within the field of applied behavior analysis (ABA). A timeline of previous calls to actions and changes within ABA that align with the inclusion of this standard is discussed along with the obstacles that hindered progress. Lastly, directions are provided for how to make behavior analytic practices more culturally responsive through confronting our personal biases, using culturally responsive pedagogies, updating and adapting our practices regarding the selection of target skills and assessment administration, and collaborating with our clients and their teams. Through an understanding of its urgency and direct applications into our work, this article seeks to aid behavior analysts in shifting our practices to being more culturally responsive.

Disability-Affirming Supervision: Future Directions in Applied Behavior Analytic Supervision

Various disciplines have undergone a shift towards increasing diversity, multiculturalism, and cultural humility in the past few years. In 2019, a Behavior Analysis in Practice special issue raised a collective call to action for increased diversity and representation within the field at both organizational and individual levels. Since that time, articles, discussions, and reports have been published providing heightened attention to cultural humility toward clients, stakeholders, and practitioners. However, little attention has been directed toward the diversity of individuals supervised by behavior analysts. In particular, effective and compassionate supervision of people with disabilities has not been addressed in the field. Practitioners and supervisors need to have the necessary knowledge and skills to be able to inclusively and effectively train and shape the behavior of supervisees with disabilities. The present article reviews the literature, research, and practices from the field of psychology and makes recommendations of tools to create a disability-affirming environment for supervision in the field of applied behavior analysis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-023-00846-5.

When Cultural Awareness Reveals Conflicting Cultural Values: A Pragmatic Approach

Cultural awareness reminds ABA service providers of the importance of considering the cultural practices of others when programming for behavior change. Decisions about the appropriateness of services may be difficult, however, when the values of the client conflict with the values of the culture(s) to which the client belongs or with the cultural biases of the practitioner. To minimize such conflicts, we propose a decision-making model that integrates client-centered and culture-centered assessments of habilitative validity. Throughout the proposed evaluation process, the behavior analyst and the recipients of services collaborate to refine program goals that will increase access to reinforcers for the client and their cultural groups. Given that cultures arrange reinforcers and punishers for the individual, assessing habilitative and social validity for the cultural groups affected by services is emphasized as an essential component of the model. We illustrate how the proposed model could be used to suggest appropriate courses of action by analyzing a situation that may involve conflicts of values.

Culture and Language Inclusion in the Practice of Applied Behavior Analysis: Next Steps for Improving Outcomes for Autistic Clients

As applied behavior analysis (ABA) is widely prescribed as an intervention for autistic children, ABA practitioners must have a thorough understanding of the impact of language and culture on the individuals and families they serve. The twin purposes of this article are to discuss cultural humility in ASD service delivery, and to provide an overview of practice parameters for the expansion of equity and inclusion. These efforts are guided by the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. Readers will be provided with recommendations for incorporating culturally and linguistically appropriate services into training, practice, and supervision in ABA settings.

A Contextual Behavioral Framework for Enhancing Cultural Responsiveness in Behavioral Service Delivery for Latino Families

In recent years, the field of behavior analysis has shifted its attention to issues of diversity, social justice, and cultural responsiveness. With various cultural groups in the United States, behavior analytic practitioners increasingly find themselves serving clients of diverse cultural backgrounds. One of the populations that continue to face underrepresentation is Latinos. In the current article, a cultural understanding of the Latino culture is provided to support cultural responsiveness in behavioral service delivery. This article explores the Latino identity of individuals receiving behavioral services, systemic barriers faced by Latinos, the use of acceptance and commitment training for Latino families and clients, and Latino cultural values and their role in behavioral service delivery. Most important, a shift in perspective to account for the barriers perceived by practitioners within the context of Latino cultural values is offered through a contextual behavioral framework, the literature, and the authors' personal and professional experiences as Latino behavior analysts. Recommendations in the areas of assessment, treatment design, service delivery, and collaboration when working with Latinos are also discussed.

Integrating Diversity, Equity, and Inclusion Readings within Coursework: Suggestions for Instructors Teaching Behavior Analysis

Behavior analysis graduate programs must train their students to be culturally responsive so that they are prepared to effectively serve a diverse clientele. One important strategy for helping students gain a culturally responsive repertoire is embedding diversity, equity, and inclusion materials into behavior analysis graduate course sequences. However, little guidance exists for selecting content related to diversity, equity, and inclusion within behavior analysis to include in behavior analytic coursework. This article provides suggested readings for diversity, equity, and inclusion within behavior analysis that can be embedded into typical course structures in behavior analysis graduate programs. Each course requirement in the Association for Behavior Analysis International's Verified Course Sequence is given specific recommendations.

Culturally Responsive Language Assessment Through a Verbal Operant Experimental Analysis

Speakers from culturally and linguistically diverse backgrounds are disproportionately identified with communication deficits, a defining feature of autism spectrum disorder. The present case study demonstrates the use of a verbal operant experimental analysis as a measure of functional language. This analysis allows a bilingual participant to switch freely between responses in Spanish and English. Prior to receiving services, a pretreatment functional analysis of verbal behavior is used to identify the speaker's present level of functional language and develop an individualized treatment plan for shaping a more complex verbal repertoire. The benefits of culturally responsive early intensive behavioral intervention are demonstrated by a posttest evaluation 5 months later. Functional analyses of language are shown to be a verbal-community-centered approach to observing and measuring the verbal behavior of speakers from diverse backgrounds.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

Using Behavioral Skills Training to Teach Functional Assessment Interviewing, Cultural Responsiveness, and Empathic and Compassionate Care to Students of Applied Behavior Analysis

Within the field of applied behavior analysis, there is a recognized need for increased training for practitioners on cultural responsiveness, as well as to improve behavior analysts' demonstration of compassion and empathy towards the families with whom they work. The present study used behavioral skills training via telehealth to teach three skillsets-functional assessment interviewing, empathic and compassionate care, and cultural responsiveness. Participants were seven graduate students who had no previous coursework in behavioral assessment and whose caseload mainly included clients who did not share the participant's cultural, ethnic, or religious backgrounds. The results showed that behavioral skills training was effective in improving performance across all three skillsets. In addition, high levels of responding maintained following the completion of the training for the majority of the participants. Several levels of social validity measures support the utility and impact of this training. The findings have implications for training practitioners on these vital skills.

The relationship between interdependent and independent self-construals and social anxiety symptom severity in a clinical sample of treatment-seeking patients

Differences in cultural orientations, such as interdependent and independent self-construals, may influence social anxiety disorder (SAD) symptom presentations. However, prior research on the association between interdependent/independent self-construals and SAD was limited to non-clinical samples. Using a treatment-seeking population with clinical levels of anxiety, the current study extends prior research by examining whether the relationship between interdependent/independent self-construals and SAD is specific to SAD or indicative of a broader relationship with anxiety or depression more generally. We also expand upon prior work by examining the effect of self-construals on treatment outcomes and whether self-construals change over time. The results showed that endorsing a less independent self-construal was associated with greater SAD symptoms specifically, and was not associated with other anxiety or depression symptom measures. Additionally, while interdependent and independent self-construals did not moderate SAD treatment outcomes, there was a decrease in interdependent self-construal and increase in independent self-construal over a course of cognitive behavioral therapy. Notably, this change over time was tied to specific items that correlated strongly with SAD symptoms. Together, these results increase our understanding of the relationship between interdependent/independent self-construals and SAD symptoms in treatment-seeking anxiety patients.

Teaching Compassion Skills to Students of Behavior Analysis: A Preliminary Investigation

Socially valid practices are at the heart of applied behavior analysis and can influence how interventions are experienced by families. However, the training of practitioners of applied behavior analysis is primarily focused on the implementation of technical procedures with little focus on therapeutic approaches. Empathy and therapeutic rapport have been associated with improved outcomes in allied professions (Beach et al., Journal of the American Board of Family Practice, 15(1), 25-38, 2006; Hojat et al., Academic Medicine, 86(3), 359, 2011; Horst et al., Journal of Child & Family Nursing, 3, 5-14, 2000), but have been minimally studied within the field of behavior analysis. In the present study, several sources were utilized to identify and define empathic and compassionate care skills. These skills were divided into three skill areas (i.e., basic interviewing skills, interest in the family, joining with the family) and taught to ABA master's students using behavioral skills training via a telehealth platform. All four participants significantly improved their engagement in compassionate care skills following training and maintained these skills in follow-up probes and with a different experimenter. Several post-study measures of outcome were taken, including social validity measures from participants, ratings of compassion from consumer and professional experts, as well as comparison measures on the Jefferson Scale of Physician Empathy. Participant reports of social validity were high, as were consumer and professional ratings of compassionate behaviors. Improvements on the Jefferson Scale of Physician Empathy were also observed. Implications for training practitioners and for expanding the focus on compassionate care skill development within the field are explored.

Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework

Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.

Recommendations for Recruitment and Retention of a Diverse Workforce: A Report from the Field

There has been increased interest and attention to the need for equity, diversity, and inclusion, in the field of applied behavior analysis in recent years. Several publications have focused on these topics and educational curricula and professional development opportunities have been developed. One aspect that has received less attention is how companies providing behavior analytic services can help to promote and sustain a diverse workforce. The purpose of this article is to provide examples and recommendations for how these overarching goals can be addressed. The examples and recommendations are described in the context of a small company that has made important strides in addressing this topic through its mission to serve members of marginalized communities.

Building a Social Justice Framework for Cultural and Linguistic Diversity in ABA

ABA may be uniquely positioned to have broader impacts with culturally and linguistically diverse (CLD) client populations, not only due to its growth and increased social acceptability, but also because a segment of the field practices within the education system. Decades of misinformation have potentially reduced the widespread reliance on learning pedagogies derived from behavior analytic research. Disseminating ABA technologies depends on an advocacy-based approach to close gaps from research-to-practice. Social justice is both an approach and a framework that can be integrated into our strategic planning for the field. This article describes how to apply social justice guidelines when working with CLD students and families. There are culturally relevant considerations that can be included in our research, training, and service delivery, in particular if we want the field to grow in a sustainable fashion. Behavior analysts must consider it an ongoing long-term objective to engage in culturally informed assessment, culturally and linguistically relevant intervention, culturally focused advocacy and collaboration with families, and use self-assessment of their cultural competence.

A Sociobehavioral Model of Racism against the Black Community and Avenues for Anti-Racism Research

Sociological researchers have made immense strides in understanding systemic racism, privilege, and bias against Black people. Relational frame theory provides a contemporary account of human language and cognition that intersects within complex external contingency systems that may provide a provisionally adequate model of racial bias and racism. We propose a reticulated model that includes nested relational frames and external contingency systems that operate at the level of the individual (implicit), communities (white privilege), and system policies (systemic racism). This approach is organized from within the framework of critical race theory as an area of sociological scholarship that captures racial disadvantages at multiple levels of organization. We extend this model by describing avenues for future research to inform anti-racism strategies to dismantle this complex and pervasive sociobehavioral phenomenon. At all levels, police violence against the Black community is provided as a case example of negative social impact of racism in our society.

Increasing Diversity Content in Graduate Coursework: A Pilot Investigation

Recent data indicate that BACB certificants are largely homogenous with respect to racial and gender identity. There is also evidence that many practitioners do not receive training in culturally responsive service delivery (CSRD). Applied behavior analysis (ABA) graduate programs would therefore benefit from incorporating training on diversity and CSRD. In this pilot investigation, a pre/post design was used to evaluate the effects of providing ABA faculty members with a supplemental diversity/CRSD curriculum on the presence of diversity/CRSD content in course syllabi. Six faculty members, who were collectively responsible for teaching courses in an ABA master's program, participated in this study. All participants were provided with a general list of resources related to diversity/CRSD in ABA. The supplemental curriculum included tailored diversity course objectives and supporting resources for courses assigned to the intervention group. Results suggest that the provision of tailored objectives and supporting resources to faculty may lead to increases in diversity/CRSD content in course syllabi. Despite the methodological shortcomings of this pilot investigation, this study represents a preliminary step toward the development of a line of empirical research on ABA graduate training and diversity/CRSD. Implications for graduate training programs in ABA and future research in this area are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-022-00714-8.

Applications of operant demand to treatment selection III: Consumer behavior analysis of treatment choice

Behavior analysts and psychologists advocate for the use of therapies and strategies based on credible, scientific evidence. Researchers and clinicians regularly advocate for Evidence-based Practices (EBPs) over questionable "alternatives" because caregivers seldom choose interventions based on scientific evidence alone. This study applied methods and concepts from Consumer Behavior Analysis to conduct a reinforcer-based evaluation of the consequences that influence treatment choices. Hypothetical Treatment Purchase Tasks (HTPTs) were designed to evaluate how utilitarian (UR; i.e., the efficacy of treatment) and informational sources of reinforcement (IR; i.e., community support for treatment) jointly influence treatment-related choices. A total of 104 caregivers were recruited using the Amazon Mechanical Turk (MTurk) framework to complete two HTPTs. Results indicated that caregivers overall favored treatments with greater IR over those with greater UR, suggesting that indirect contingencies for treatment choices exerted greater overall influence than the direct contingencies of treatment choices (i.e., efficacy). This finding extends the literature on treatment choice by providing a reinforcer-based perspective on why 'fad', questionable, and pseudoscientific practices can achieve and maintain high levels of adoption by caregivers. This work concludes with a discussion of Consumer Behavior Analysis and how reinforcer-based interpretations of choice can be used to improve efforts to support and advocate for evidence-based child behavior treatments.

Cultural responsiveness in applied behavior analysis: Research and practice

The new Ethics Code for Behavior Analysts requires that certificants engage in training related to culturally responsive service delivery (BACB, 2020). There is limited work in the area of culturally responsive evidence-based practice within our field. Therefore, it is incumbent on researchers and practitioners to identify best practices for working with diverse populations. Hence, the purpose of this paper is three-fold: a) to review research within and outside the field of ABA related to culturally responsive assessment and treatment and provide practice recommendations, b) to examine the extent to which current practices in behavior assessment and treatment align with aspects of culturally responsive practices, and c) to inspire research in the areas of behavior assessment and treatment to identify best practices with regard to culturally responsive behavior analytic practices. The content of this paper is grounded in the framework described by Beaulieu and Jimenez-Gomez (2022).

Cultural Responsiveness Framework in BCBA® Supervision

Behavior analytic supervisees need to master technical and conceptual skills in their fieldwork and training. Recently, the profession has recognized the need for cultural responsiveness to be emphasized and woven throughout clinical practice and supervision. However, findings from research within applied behavior analysis (ABA) yield limited information on specific methods to increase one's cultural responsiveness, as well as few tools to identify areas of development. This paper highlights challenges BCBA®s face in providing culturally responsive supervision. The authors also make recommendations for specific areas of focus in the pursuit of culturally responsive training and skill development through the introduction of the Culturally Responsive Supervision Self-Assessment (CRSS) tool. Cultural constructs that could be addressed using the CRSS tool include, but are not limited to, race, religion, gender conformity, and intersectional paradigms of culture.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40617-022-00688-7.

Ignorance and Cultural Diversity: the Ethical Obligations of the Behavior Analyst

Applied behavior analysis (ABA) has featured an increasing concern for understanding and considering the cultural diversity of the populations behavior analysts serve in recent years. As an expression of that concern, the new BACB's Ethics Code for Behavior Analysts is more explicit and comprehensive in its inclusion of ethical obligations concerning cultural diversity. The purpose of this paper is to offer a discussion on the limitations of both our capacity and willingness to know and overcome our ignorance about our own and other cultures. We examine different ways in which our ignorance of other cultures plays out even in willful compliance with the BACB ethics code. We suggest part of the problem is that the BACB ethics code seems to operate under the assumption that practitioners are always aware or can be aware of what they do not know and of their biases. In contrast, we offer a reflection on a more complex picture of our understanding of ourselves and other cultures, where we cannot assume people are aware of what they ignore and of their biases. Ethically, we find that in some cases these blindspots are accounted for by the BACB ethics code and should be foreseen and addressed by the behavior analyst (BA). But in other cases, when a person is not aware of what they ignore, understanding the connection between cultural diversity ignorance and professional behavior requires a different approach. Our analysis suggests an attitude of being thoughtfully diligent and humble while learning about cultural diversity issues and examining the areas where we might be ignorant and not aware of our ignorance. We argue that BAs' obligations to respect the dignity of clients and their families and to provide effective treatment call for this attitude of diligence and humility that goes beyond mere compliance.

Cultural responsiveness in applied behavior analysis: Self-assessment

Culture has a substantial impact on a wide range of behaviors related to behavioral research and services such as rapport building, preferences for specific targets and treatments, communication, and even the quality of health care. The need for professionals in the field of applied behavior analysis (ABA) to incorporate culturally responsive practices is underscored by the current and projected increase in diversity in the United States. Further, the update to the Ethics Code (BACB, 2020) supports addressing diversity in behavior analytic practice. Self-assessment of one's values, biases, and culture are a critical step in delivering culturally responsive services. The purpose of this paper is three-fold: a) to introduce a framework for cultural responsiveness in ABA, b) to showcase research and practice recommendations from within and outside the field of ABA in the area of self-assessment, and c) to inspire research in self-assessment to support cultural responsiveness in ABA.

Values: A Core Guiding Principle for Behavior-Analytic Intervention and Research

Values represent qualities or beliefs that are of high priority to individuals or society and represent one of the core processes within acceptance and commitment therapy or training (ACT or ACTr). The current article discusses values and valuing not only as a centralized process in ACT but also as a core process guiding the field of applied behavior analysis with applications that extend across several intervention domains. A relational frame theory model of values as hierarchical frames that augment reinforcing functions that can influence socially meaningful behavior change is reviewed. This basic model is then extended to encompass temporal, deictic, and causal frames. Values-based intervention research is emerging in areas such as guided decision making, professional development, organizational behavior management, parent training, and treatment plans for children and adults. Although this research is promising, more work is needed to further explore the role of values and valuing within ACT, and when they are used within other intervention strategies. Several potential avenues for future research that may aid in the development of values-based intervention by behavior analysts and extend the scope of our field and practice are discussed.

Soft Skills: The Case for Compassionate Approaches or How Behavior Analysis Keeps Finding Its Heart

As the field of behavior analysis expands, our need to develop ourselves as more effective collaborators, particularly with families who may be the primary consumers of our science, becomes paramount. As scientists, our training lies primarily in the behavior analytic technologies that we study and apply. But our ability to disseminate our science, collaborate with non-behavior analysts, and ultimately grow our field hinges on our ability to navigate interpersonal situations in a way that puts forth compassion and humanity. We have the opportunity and capability to use our empirical procedures to implement and assess the effectiveness of interventions that target the soft skills of our field. The current article discusses the benefits of empathic and collaborative approaches in fields related to behavior analysis and provides suggestions for current behavior analysts to incorporate compassionate care into their practices. We provide a checklist for compassionate interactions accompanied by possibilities for its use as a tool for self-evaluation, procedural fidelity, and comprehensive training in the area of collaboration with families. Finally, we discuss areas for future research with respect to assessing and improving behavior analysts' compassionate approaches to treatment.

Initiatives to Address Diversity, Equity, and Inclusion Within a Higher Education ABA Department

Recent events have highlighted the need for behavior analysis to address issues of diversity, equity, and inclusion (DEI) in service provision and in higher education. There has been a call to action issued, noting the need for cultural humility and cultural responsiveness. An opportunity exists within training programs to ensure that students of behavior analysis are instructed in ways that promote cultural responsiveness and that equip them to serve diverse populations. Additionally, more needs to be done to engineer environments where students of behavior analysis are treated with respect and compassion, and to ensure that educational environments promote the comfort and success of all students. This article outlines the initiatives of an applied behavior analysis department to gather information about DEI on the local level, identify goals, implement change, and evaluate progress toward these goals.

Culturally Relevant Pedagogy and Applied Behavior Analysis: Addressing Educational Disparities in PK-12 Schools

The purpose of this article is to describe the theory of culturally relevant pedagogy (CRP) and its application to PK-12 education for behavior analysts working in schools. CRP is an educational framework that asserts that successful teachers of African American students help their students gain three repertoires: (1) sociopolitical awareness, (2) cultural competence, and (3) academic excellence. The CRP framework was designed to counter the effects that racial bias has on the academic and disciplinary experiences of some students of color. This article suggests that applied behavior analysis and CRP, when used together, may strengthen educators' efforts to reduce the effects of racism that some students of color experience. The authors first explain the tenets of CRP based on the work of Ladson-Billings (1995a, 1995b). Next, points of convergence between ABA and CRP are described. Finally, the authors offer recommendations for behavior analysts to consider when applying CRP in schools through the provision of examples of strategies and tactics derived from the behavioral literature that align with the CRP framework. The framework presented in this article has implications for behavior analysts interested in applying culturally relevant practices to their work as educators.

Increasing Access and Quality of Behavior-Analytic Services for the Latinx Population

Latinxs are the largest minority group in the United States, making up approximately 18% of the total population. Although there is a critical need for the behavioral health care system, including behavior analysts, to provide services to support the needs of the Latinx community, access to quality behavioral and mental health services continues to be lacking for the Black, Indigenous, and people of color populations. This article highlights some of the cultural and language factors that should be considered by behavior-analytic providers who have a shared responsibility to make culturally and linguistically appropriate services available to this population. Additionally, recommendations for systemic action across service providers, professional organizations, behavior-analytic training programs, and researchers are suggested to address these barriers. Recommendations for bringing about this systemic change are suggested across three domains: (a) increasing diversity in the behavior-analytic workforce, (b) enhancing training in cultural- and language-related issues, and (c) conducting research on cultural and language adaptations to behavior-analytic evidence-based treatments.

LGBTQ+ conversion therapy and applied behavior analysis: A call to action

The term conversion therapy refers to any practices intended to alter a person's sexual orientation, gender expression, gender identity, or any combination thereof. The present-day scientific consensus is that such practices are not only ineffective, but highly harmful and fundamentally unethical. However, historical connections exist between applied behavior analysis and the design and dissemination of conversion therapy practices. The purpose of this paper is to highlight these connections and to call for further attention and action from contemporary behavior analysts on this matter. Specifically, we call for continued discussion and review of previously published conversion therapy papers according to present-day guidelines for ethical research, position statements from professional organizations, additional ethics guidelines for behavior-analytic practice, and future behavior-analytic research and practice efforts that support LGBTQ+ people.

Ending the School-to-Prison Pipeline: Perception and Experience with Zero-Tolerance Policies and Interventions to Address Racial Inequality

This study expands the current research on anti-Black racism and student discipline in schools. It examines perception, experiences, and alternatives of zero-tolerance policies in education, in relation to the call for action by Black Lives Matter at Schools. Black, Indigenous, and People of Color (BIPOC) students are affected at a disproportionate rate when it comes to school discipline, leading to high, inequitable incarceration rates. However, behavior analysis already has powerful tools and interventions that can stop this "school-to-prison pipeline" effect. A survey of school professionals investigated awareness of adverse outcomes from zero-tolerance policies and the use of effective, behavioral alternatives to exclusionary disciplinary practices. Results confirmed zero-tolerance policies still exist in North American schools, but that school professionals, including behavior analysts, support Black Lives Matter at School's call to end such practices. It is important to note that participants report already having the necessary skills to combat zero-tolerance; however, many still feel uncomfortable or ill-prepared to implement interventions specifically intended to decrease anti-Black racism in schools.

Guidance for Behavior Analysts in Addressing Racial Implicit Bias

In the practice of applied behavior analysis (ABA) treatment, implicit bias, which can be defined in behavioral terms, needs to be addressed because it may inadvertently lead to overt forms of discrimination on the basis of race. Although little research has been conducted within the field of ABA on racial implicit bias, information gathered from related fields can provide insight as to how behavior analysts can promote positive change in this area. Drawing from existing literature, recommendations are provided regarding assessment and administration of interventions to reduce racial implicit bias for clinicians. The purpose of this article is to provide strategies that behavior analysts can implement to assess and reduce behaviors related to implicit bias exhibited by practitioners, thereby reducing racial discrimination with clients and staff.

A Preliminary Assessment of the Qualities and Behaviors of Exemplary Practitioners: Perspectives From U.S.-Based Behavior Analysts

Individuals with credentials (Board Certified Behavior Analyst-Doctoral and Board Certified Behavior Analyst) from the Behavior Analyst Certification Board throughout the United States were asked to identify the characteristics and corresponding behaviors of individuals they consider to be exemplary in the profession. From these responses, a list of 35 characteristics and attendant behaviors was compiled into the Exemplary Behavior Analyst Checklist. This checklist contains a number of characteristics that are traditionally representative of the field (e.g., analytical, applied, conceptually systematic, technological) and relate to technical and conceptual skills. Respondents also identified a number of characteristics associated with compassion and support of clients/individuals (e.g., client centered, culturally competent, empathetic, positive/encouraging). A "top 10" list of the qualities and behaviors of exemplary behavior analysts identified by participants is presented, and a discussion regarding the implications for the training of credentialed professionals is provided.

Anger, Fear, and Sadness: How Emotions Could Help Us End a Pandemic of Racism

Racism, recently referred to as another kind of pandemic, affects the health and safety of diverse individuals within the United States and around the world. Emotions are a powerful and integral aspect of the experience of racism; however, within the field of behavior analysis, we have been hesitant to acknowledge emotion or explore how it relates to behavior and behavioral contingencies. As a result, the scope of our understanding of emotion is limited. To better understand the current experience and perception of practitioners in the field of behavior analysis, as they relate to emotion and racism, a brief survey was conducted. Findings indicated that although many may be comfortable discussing emotion and displaying emotions for themselves and others, this was not the case for everyone. Further, many were uncomfortable discussing racism. Although participants believed that emotions of racism are important and should be addressed by the field of behavior analysis, they think the field has not done enough work in this area. The results of the study lead to several recommendations, including additional antiracism research and the acknowledgment of emotional experience, as well as for how individuals can better understand, and maybe reduce, the negative emotions associated with oppression.

Black Caregivers' Perspectives on Racism in ASD Services: Toward Culturally Responsive ABA Practice

Significant racial and ethnic disparities in health care and service access exist. In the present article, we reviewed qualitative studies investigating the racism-related experiences of Black caregivers of children with autism spectrum disorder (ASD) in the U.S. health care system. Specifically, we examined institutional racism (i.e., systemic racism) and individual racism directed toward Black families when they seek diagnoses and services for their children with ASD. Additionally, we summarized culturally responsive and context-specific practice guidelines to work collaboratively with Black caregivers of children with ASD for applied behavior analysis practitioners.

Solidarity: The Role of Non-Black People of Color in Promoting Racial Equity

Multicultural behavior analysts must stand together to address the issues of systemic racism collectively, show solidarity, and support Black lives. This article discusses the role of culturally and linguistically diverse behavior analysts, the mechanisms underlying barriers to showing solidarity, and the mechanisms required for cultural evolution to promote a compassionate and nurturing approach to racial equity. It is critical that non-Black people of color actively participate in antiracist advocacy to express solidarity with the Black Lives Matter movement.

Shared clinical decision-making experiences in nursing: a qualitative study

Background

Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM.

Methods

This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data.

Results

The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors.

Conclusions

The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00597-0.

Cultivating the Ethical Repertoires of Behavior Analysts: Prevention of Common Violations

Violations of the Professional and Ethical Compliance Code for Behavior Analysts occur despite coursework, supervision, and training. In this discussion, we highlight the most common violation categories identified: (a) improper or inadequate supervision/delegation, (b) failure to report/respond to the Behavior Analyst Certification Board (BACB) as required, and (c) professionalism/integrity. The specific areas addressed under supervision/delegation involve behavior analysts' standards and performance as supervisors, as well as compliance with coursework. For failure to report, the focus is on responding, reporting, and providing updated information to the BACB in a timely manner. Finally, the section on professionalism and integrity addresses multiple code elements, including integrity, professionalism, and scientific relationships, as well as methods for promoting an ethical culture and decisions involving ethical violations by others. Importantly, we provide guidance on the structure and organization of supervision, methods and guidelines regarding reporting, and rubrics to shape and evaluate professionalism and integrity. We provide recommendations for the supervision process and for practitioners from the organizational perspective so that the organization supports and promotes an ethical culture.

Ethical Considerations in Clinical Supervision: Components of Effective Clinical Supervision Across an Interprofessional Team

Within the practices of behavior analysis, education, occupational therapy, physiotherapy, speech-language pathology, and other health professions, professional practice focuses on each discipline's ethics, assessment, and treatment practices. However, maximizing outcomes for some clients is achieved only by combining the strengths of multiple disciplines to include all the competencies required for comprehensive client care. Thus, understanding and acquiring the core competencies for working collaboratively within an interprofessional framework is essential for working together effectively to garner the best outcomes for clients. Furthermore, the interprofessional team clinical supervisor has the added responsibility of ensuring optimal client outcomes while managing a diverse group of professionals, each with their own set of perspectives, clinical training, and evidence-based practices. In many areas of applied practice, the behavior analyst assumes the role of interprofessional clinical supervisor, which necessitates additional training in collaboration, supervision of allied professionals, and ethics. Successful interprofessional and collaborative working relationships require a number of key competencies and subcompetencies as outlined by the Interprofessional Education Collaborative, as well as knowledge of others' ethical and professional codes and/or guidelines for professional conduct, along with additional training and resources in the navigation and handling of ethical dilemmas among disparate team members. Working together and maintaining professional relationships within an interdisciplinary team are fraught with barriers and issues that may impede collaboration. The interprofessional team clinical supervisor requires various strategies, processes, and resources to enable them to navigate challenges and assist the team in working cohesively to achieve more positive client outcomes.

Toward the Development of Antiracist and Multicultural Graduate Training Programs in Behavior Analysis

Racist policies and inequity are prevalent in society; this includes higher education institutions. Many behavior-analytic training programs have been complicit in omitting cultural humility and antiracist ideas from their curricula and institutional practices. As societal demands for allyship and transformational change increase, programs must rise to the challenge and act as agents of change in our clinical, professional, and personal communities. The current article offers a multitude of strategies for institutions to develop an antiracist and multicultural approach. These recommendations encompass policies that may be promoted at the following levels: (a) in organizational infrastructure and leadership, (b) within curricula and pedagogy, (c) in research, and (d) with faculty, students, and staff.

Barriers and Facilitators of Access to Psychological Services for Indigenous Populations: A Scoping Review and Thematic Analysis

Background: The extent to which behavior-analytic interventions are offered to Indigenous populations across CANZUS in accessible and culturally appropriate ways is unknown. We conducted a scoping review with a thematic analysis of the extant literature to find: (1) what are the barriers and facilitators for providing effective and equitable delivery of psychological services (with a behavioral component) to Indigenous populations; and (2) what tools and practices exist for an effective and equitable service delivery. Methods: We systematically reviewed Medline, CINAHL, PubMed, PsycInfo, Web of science, Ovid and INNZ databases between 1990 and 2020. For the scoping review, we adhered to the JBI methodological approach (2015) and the PRISMA strategy for the identification, selection, and appraisal of the reviewed articles. A total of 1265 unique articles met the criteria for the screening by title; 238 by abstract; 57 were included for full text assessment; and 37 were included in the final analysis. Results: Three themes were revealed to account for the barriers and facilitators of culturally friendly practices: (1) connecting practices are about interactions shaping the relationship between service provider and service client; (2) innovative practices test new approaches and innovations that could facilitate access to psychological services and overcome barriers, and (3) reflective practices are about critically examining the processes and actions undertaken toward effective cultural adaptation of services. Conclusions: Our analysis suggests that the level of success in bringing together services and the recipients of treatment (connection), showing flexibility and persistence in finding solutions (innovation) and examining the role of our behaviors in reaching our goals (reflection) is determined by the providers' action in the aforementioned three dimensions of practice.

Evaluating the Efficacy and Social Validity of a Culturally Adapted Training Program for Parents and Service Providers in India

In regions such as India, where one-to-one behavior-analytic intervention is not easily accessible, parents and service providers may advocate for children with disabilities better if they have foundational training in behavioral approaches to problem behavior. The purpose of this study was to evaluate a culturally adapted training delivered in an underresourced region of India. Ten parents and professionals from Chennai completed the training, and the researchers evaluated its effects using a multiple-baseline design. Participants showed improvements in correct responses on a structured form designed to capture skills involved in function-based assessment and intervention, as well as the fidelity of implementation of extinction and functional communication training. Moreover, participants rated the acceptability of training highly on measures of social validity. Guidelines for the education of parents and service providers in underresourced areas outside of the United States are discussed.

Organizational Transformation to Improve Breast Cancer Screening Behaviors in Iranian Women: A Qualitative Study

Breast cancer is the most common cause of premature mortality among women, and screening is one of the most important means of early diagnosis of breast cancer. This qualitative study was conducted to explore strategies for promoting breast cancer screening behaviors from the perspective of health volunteers in south-east Iran. Data collection was performed through focus groups. Using the purposive sampling method, 35 participants were selected and data were analyzed using a specific qualitative content analysis framework. By analyzing the data to provide strategies for promoting breast cancer screening behaviors, the main theme of "organizational transformation" with five subthemes including the promotion of health-centered beliefs in society, the development of culture-based training, the media revolution, financial support, and the provision of efficient health-care providers were extracted. According to the results of the study, the development of organizational transformation plays an important role in planning for the promotion of breast cancer screening.